WOMEN'S HEALTH AND THE AHCA

On May 4, the House of Representatives passed its Obamacare repeal the American Healthcare Coverage Act. As a future physician who cares about health equity and health access, I find the bill to be incomprehensible. While ostensibly passed to lower premiums, the bill does little to resolve the root cause(s) of the rising costs of healthcare and instead insurance companies to revert back to predatory plans which do not actually cover citizens. Beyond capping and reducing Medicaid funding in general, the bill is particularly concerning for folks who care about women’s health.

The AHCA proposes to prevent federal Medicaid reimbursement at Planned Parenthoods across the country. For many women, Planned Parenthood is the only available clinic to provide needed health screening and family planning programs. For a party devoted to getting government out of the public sphere, Republicans are trying to justify choosing for millions of women which clinic they can access care. Let’s also be clear, the Hyde Amendment already prevents federal funding for Medicaid from funding abortion, so this new additional legislation will arbitrarily restrict reimbursement for contraception, primary care and referrals. Unbelievable.

Additionally, the AHCA bans abortion coverage for all insurance plans purchased in the Marketplace (the marketplace for individual insurance not covered by employee insurance) as well as preventing any federal subsidies on plans outside of the marketplace which cover abortion. Again, this piece of a legislation is a massive overstep in states rights and the right of the individual. In NY state which mandates the coverage of abortion in insurance plans, this means that no insurance plans could be subsidized or available on the Marketplace. This is a blatant attempt of the Republican party to step on the rights of women and their reproductive choices.

Despite maintaining a ban on gender rating, the AHCA also allows for states to obtain a waiver to allow insurance companies to charge higher premiums to those with pre-existing conditions. Given the fact that these pre-existing conditions prior to the ACA included pregnancy, prior C section or breast cancer, women in states who adopt this waiver could see premiums exponentially sky rocket. So, in addition to denying women on Medicaid access to Planned Parenthood, the AHCA could conceivably make healthcare unaffordable for women above the federal poverty line.

The essential health benefits covered by the ACA also mandated coverage of maternity and newborn care. This means that all insurance plans must cover maternity Under the new AHCA, states can apply for a waiver to define their own essential health benefits and potentially allow for the creation of predatory insurance plans which do not cover obstetrical care. Because obstetrical care can cost anywhere from $30,000- $50,000 in the USA, this lack of coverage would have devastating consequences to women. In addition to the restrictions on abortion coverage, women who become pregnant under the AHCA face serious economic hardship with limited options.

Lastly, while not discussed directly in the AHCA, both Trump, Pence and Republicans in Congress have discussed scaling back funding for contraceptive coverage provided under the ACA (which mandates making all FDA-approved contraception free of charge). To recap, the AHCA proposes to eliminate a critical women’s health center, mandate abortion restrictions on health insurance, make healthcare more expensive for those who have previously given birth and limit maternity coverage. Additionally, the administration is hostile to contraceptive access in general. Pregnancy, abortion and contraception all seem to be antithetical to Republican values. So what are people with uteruses meant to do?